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Q&A: Early Pancreatic Cancer Diagnoses Provide Best Chance for Long-Term Survival
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November is Pancreatic Cancer Awareness Month, a campaign to draw attention to the disease, and raise funds for early diagnosis research and to raise awareness in various communities.
In the United States, approximately 55,440 adults will be diagnosed with pancreatic cancer in 2018, according to the American Cancer Society. Additionally, approximately 44,330 will die of the disease.
One in 63 men and 1 in 65 women have a lifetime risk for developing pancreatic cancer, according to the American Cancer Society.
Healio Gastroenterology and Liver Disease spoke with Victoria Manax, MD, chief medical officer at Pancreatic Cancer Action Network, and Michael Goggins, MBBCh, MD, director of the Pancreatic Cancer Early Detection Laboratory at Johns Hopkins Hospital, about pancreatic cancer screening as well as the benefits of early detection.
Healio: How would you best advise physicians to approach patients about getting screened for pancreatic cancer?
Goggins: Pancreatic screening is recommended only for those who meet certain risk criteria. Individuals who are generally aged 55 years and older who have a family history of multiple pancreatic cancers, including at least one parent or sibling and at least one additional affected relative are recommended for screening. Additionally, individuals who carry inherited gene mutations that predispose to pancreatic cancers, such as BRCA2, ATM, BRCA1 and PALB2, and are of an age where screening would be considered appropriate, can undergo screening.
Manax: In addition to risk factors associated with family history, individuals could be at an increased risk for developing pancreatic cancer due to chronic or familial pancreatitis, smoking, obesity or new-onset of diabetes after the age of 50. It’s important for health care professionals to ensure that their patients are aware if they’re at an increased risk for developing pancreatic cancer, and that the doctors and patients know to watch for the symptoms of the disease.
Healio: Pancreatic cancer has been considered rather difficult to detect in its early stages. Why would you say this is the case?
Goggins: Many cancers do not cause symptoms when they are small. Pancreatic cancers usually do not cause symptoms until they are beginning to spread beyond the gland. The use of cancer screening tests recognizes that symptoms are an unreliable way to diagnose cancer at an early stage.
Manax: Pancreatic cancer may cause only vague unexplained symptoms. Pain (usually in the abdomen or back), weight loss, jaundice (yellowing of the skin and/or eyes) with or without itching, loss of appetite, nausea, change in stool, pancreatitis and recent-onset diabetes are symptoms that may indicate pancreatic cancer. If someone is experiencing one or more of these symptoms, we urge them to speak to their doctor immediately and reference pancreatic cancer.
Healio: What types of imaging procedures do you recommend and what are the pros and cons of those procedures?
Goggins: I recommend an MRI or an MRCP. The advantages to either procedure are that they are minimally invasive and offer very detailed views of the pancreas, especially the pancreas ductal system. The disadvantages associated with these procedures include the cost, very rare adverse effects associated with the contrast and claustrophobia for some people.
Additionally, there are advantages to using endoscopic ultrasound. An endoscopic ultrasound offers a very detailed exam of the pancreas, and can detect relatively small cancers, considered 1 cm or less in diameter. However, there are disadvantages that include cost and small risks related to undertaking an endoscopy and undergoing sedation.
Healio: What is the goal of detecting pancreatic cancer early?
Manax: Diagnosing pancreatic cancer in its earlier stages increases patients’ access to surgery and other potentially effective treatment options and provides the best opportunity for long-term survival. We and others are working to develop and standardize early detection strategies to enable more patients to be diagnosed before their disease has spread, with the aim to improve patient outcomes.
References:
https://www.cancer.org/cancer/pancreatic-cancer/about/key-statistics.html
Disclosures: Goggins and Manax report no relevant financial disclosures.